Search Results (114)

Using multifunctional dual-cure smart bioactive resin luting agents (DRLs) offers benefits in adhesive dentistry, but their optical stability remains a concern. Their pre-cured form is a shear-thinning structure with thixotropic gel-like behavior. The effect of their hydrophilicity and different thicknesses of nanoceramic hybrid on the final shade of milled esthetic restorations needs further investigation. This study examined how the optical function deterioration of dual-cure smart bioactive resin luting agents used to bond a CAD/CAM nano-ceramic hybrid composite would influence the restoration’s final shade at three different thicknesses. A nanoceramic hybrid composite (GD) was cut into blocks and grouped by thickness (0.8, 1.0, 1.5 mm). Ten blocks from each group were assigned to subgroups based on the DRL type: Panavia SA Universal (PN), Predicta Bioactive (PR), and ACTIVA BioACTIVE (AC). Color and whiteness changes after a 24 h/day (24 days) coffee immersion were analyzed using statistical methods (ANOVA and Tukey’s HSD for ΔE₀₀; Welch’s ANOVA and Games-Howell for ΔWI_D and ΔL*). DRL type significantly affected ΔE₀₀, ΔWI_D, and ΔL* (p < 0.001). All materials showed the least color change and optical function deterioration at a restoration thickness of 1.5 mm, which was below the acceptability threshold (AT). Despite PR’s bioactive functionality, it maintained its primary optical function with the least color change at GD thicknesses of 1.0 and 1.5 mm (p < 0.001). AC exhibited the greatest ΔE₀₀ above AT, especially at a thickness of 0.8 mm (p < 0.001). ΔL*, ΔE₀₀, and ΔWI_D varied significantly based on DRL type, GD thickness, and the interaction between DRL and thickness (p < 0.05). This suggests that although dual-cure smart DRLs containing bioactive glasses are advantageous, their optical function shifts may become more noticeable in thin, translucent restorations. Increasing the restoration thickness can help mitigate this by altering the optical pathway. Full article

The aim was to evaluate the shear-bond strength (SBS) of experimental short fiber-reinforced CAD/CAM composites (SFRC-CAD) and commercial CAD/CAM composites (Cerasmart 270) to different luting resin composites before and after hydrothermal aging. Discs (2 mm) obtained from SFRC-CAD and Cerasmart 270 were air-particle abraded and treated with a primer (G-CEM One Enhancing Primer) with or without universal adhesive (G2 Bond). A fiber-reinforced flowable composite (everX Flow) and a self-adhesive resin cement (G-CEM One) were used as luting materials under direct or indirect curing conditions. Thirty-two experimental groups were determined based on restorative material, bonding protocol, luting resin, curing technique, and aging procedure (n = 8/group). SBS was measured after 24 h of water storage or following hydrothermal aging. Data were analyzed using nonparametric statistical tests (p < 0.05). No statistically significant differences in SBS were observed between everX Flow and G-CEM One regardless of the bond application (p > 0.05). SFRC-CAD bonded with everX Flow and universal adhesive demonstrated significantly higher SBS than the corresponding Cerasmart groups (p < 0.05), whereas no significant differences were observed between comparable groups when G-CEM One was used. Failure mode analysis showed predominantly adhesive and mixed failures, with no cohesive failures within SFRC-CAD. Overall, the everX Flow proved to be an effective luting material, indicating that this material may be suitable for luting CAD/CAM indirect restorations. Full article

The present study describes a digitally guided workflow for the Split Bone Block Technique (SBBT) using standardized cortical and particulate allogeneic grafts in combination with custom-designed, 3D-printed surgical guides. The aim was to illustrate the feasibility of a donor-site-free alternative to the conventional autologous approach, which remains technically demanding and associated with increased morbidity. A narrative literature review and a single clinical case report were conducted to contextualize the proposed workflow. Digital planning was performed by merging DICOM and STL datasets to design cutting boxes for standardized allogeneic laminae and a transporter guide for intraoperative positioning. The technique was applied in a patient with severe horizontal ridge atrophy. Primary wound closure and uneventful healing were achieved. Six-month CBCT evaluation demonstrated an increase in horizontal ridge width from 2 mm to 8 mm. Within the limitations of a single illustrative case, this report suggests that a fully guided allogeneic SBBT workflow is feasible and may facilitate controlled graft adaptation while avoiding autologous bone harvesting. Further controlled clinical studies are required to evaluate accuracy, reproducibility, and long-term outcomes. Full article

The existing scientific literature indicates that flowable short fiber-reinforced composites (SFRCs) can be used for direct restoration due to their favorable mechanical properties. However, there is a lack of data on the mechanical properties of SFRCs designed specifically for indirect CAD/CAM restorations. This study aims to fabricate a novel experimental SFRC CAD/CAM block and evaluate its fracture toughness and polishability as an indirect restoration in comparison with different conventional resin-based CAD/CAM blocks with different compositions. Fourier-transform infrared spectroscopy (FTIR) was employed to analyze the chemical structure of the Experimental SFRC group, while the microstructure of specimens from each group was examined using scanning electron microscopy (SEM). Then, this study divided the specimens into three groups—Group 1 (Grandio blocks), Group 2 (Cerasmart 270), and Group 3 (Experimental SFRC)—with 30 specimens in each group. Each group was then subdivided into sub-groups for the fracture toughness test, which evaluated resistance to crack propagation, and the surface roughness test, which assessed surface topography. FTIR analysis showed that the experimental SFRC exhibited distinct spectral changes after polymerization, confirming successful chemical reactions and network formation. SEM analysis showed that the Experimental SFRC block had a polymeric matrix with randomly oriented, well-dispersed short fibers. Grandio blocs exhibited a dense nanohybrid structure with irregular fillers, while Cerasmart 270 displayed a more uniform microstructure with evenly dispersed nano-sized spherical fillers. The Experimental SFRC showed the highest fracture toughness (2.758 MPa·√m), surpassing the other groups (p < 0.05) and highlighting its superior resistance to crack propagation. Regarding surface roughness Ra, the novel Experimental SFRC group (0.182) presented a significant difference compared to other groups (p < 0.05) but within clinical acceptance, and they can be well polished for clinical use after milling. The Cerasmart 270 block showed the lowest surface roughness Ra (0.135) among the groups, which is attributed to its filler size, geometry, and composition, resulting in a smoother surface. The higher fracture toughness of the Experimental SFRC among the groups suggests superior resistance to crack propagation, attributed to the incorporation of short fibers that enhance energy absorption and reduce brittleness, thereby supporting its suitability for high-stress-bearing clinical applications. Full article

The clinical performance of interim restorations, particularly in the anterior region, largely depends on surface roughness (Ra) and color stability. This study investigated the influence of different toothbrushing durations on the surface roughness and color stability of CAD/CAM interim restorative materials subjected to varying polishing protocols. A total of 140 rectangular specimens (15 × 9 × 2 mm) were fabricated from highly cross-linked PMMA blocks (Telio-CAD, Ivoclar Vivadent, Schaan, Liechtenstein) and allocated to two surface treatment groups: conventional polishing and surface coating with Optiglaze Color (GC Corp, Tokyo, Japan). Each group was further divided into seven subgroups (n = 10), including a control (no brushing) and groups that performed simulated brushing (DentArge TB-6.1, Analitik Medikal, Gaziantep, Turkiye) with distilled water or toothpaste (Colgate Total; Colgate-Palmolive, New York, NY, USA), for 2 weeks, 3 months, or 1 year. Ra values were recorded before (Ra0) and after brushing (Ra1), and color changes (ΔE₀₀) following immersion in coffee solution were calculated. Statistical analysis was performed using a three-way ANOVA and Tukey’s HSD test (α = 0.05). Specimens coated with Optiglaze Color exhibited significantly lower Ra values compared with conventionally polished specimens (p < 0.05). The Con_Tp_1Yr group demonstrated the highest Ra value (0.53 ± 0.08 µm) compared to all other specimen groups (p < 0.05). A one-year brushing duration markedly increased ΔE₀₀ values in both surface treatment groups regardless of brushing medium (p < 0.05). While surface coating was more effective than conventional polishing in obtaining smoother surfaces at all brushing durations, prolonged brushing with toothpaste produced a progressive increase in surface roughness in both treatments. Ra values increased consistently over time, with the most pronounced changes observed after one year of brushing. Within the limitations of using a single CAD/CAM material, it may be concluded that surface coating improves the initial smoothness of interim crowns; however, extended brushing and different brushing media can intensify color changes, indicating that the long-term stability of surface-coated interim restorations may be compromised under abrasive conditions. Full article

The aim of this study is to evaluate the mechanical properties and long-term stability of 3D-printable resins for permanent fixed dental prostheses (FDPs), focusing on whether material performance is influenced by 3D-printer type or by differences in resin formulations. Specimens (N = 621) were printed. CAD/CAM blocks (BRILLIANT Crios) served as control. Flexural strength (FS) with elastic modulus (E_calc), Weibull modulus (m), Martens’ hardness (HM), indentation modulus (EIT), elastic modulus (E_RFDA), shear modulus (G_RFDA), and Poisson’s Ratio (ν) were measured initially, after water storage (24 h, 37 °C), and after thermocycling (5–55 °C, 10,000×). SEM analysis assessed microstructure. Data were analyzed using Kolmogorov–Smirnov, ANOVA with Scheffe post hoc, Kruskal–Wallis with Mann–Whitney U, and Weibull statistics with maximum likelihood (α = 0.05). A ceramic crown printed with Midas showed higher FS, HM, and EIT values after thermocycling than with Pro55s, and higher E_calc scores across all aging regimes. A Varseo Smile Crown Plus printed with VarseoXS and AsigaMax showed a higher FS value than TrixPrint2, while AsigaMax achieved the highest initial E_calc and E_RFDA values, and VarseoXS did so after thermocycling. HM, EIT, and G_RFDA were higher for TrixPrint2 and AsigaMax printed specimens, while ν varied by system and aging. 3Delta Crown, printed with AsigaMax, showed the highest FS, E_calc, HM, EIT, and m values after aging. VarseoSmile triniQ and Bridgetec showed the highest E_RFDA and G_RFDA values depending on aging, and Varseo Smile Crown Plus exhibited higher ν initially and post-aging. Printer system and resin formulation significantly influence the mechanical and aging behaviors of 3D-printed FDP materials, underscoring the importance of informed material and printer selection to ensure long-term clinical success. Full article

Diabetic Retinopathy (DR) is a leading cause of vision impairment globally, underscoring the need for accurate and early diagnosis to prevent disease progression. Although fundus imaging serves as a cornerstone of Computer-Aided Diagnosis (CAD) systems, several challenges persist, including lesion scale variability, blurry morphological patterns, inter-class imbalance, limited labeled datasets, and computational inefficiencies. To address these issues, this study proposes an end-to-end diagnostic framework that integrates an enhanced preprocessing pipeline with a novel deep learning architecture, Hierarchical-Inception-Residual-Dense Network (HIRD-Net). The preprocessing stage combines Contrast Limited Adaptive Histogram Equalization (CLAHE) with Dilated Difference of Gaussian (D-DoG) filtering to improve image contrast and highlight fine-grained retinal structures. HIRD-Net features a hierarchical feature fusion stem alongside multiscale, multilevel inception-residual-dense blocks for robust representation learning. The Squeeze-and-Excitation Channel Attention (SECA) is introduced before each Global Average Pooling (GAP) layer to refine the Feature Maps (FMs). It further incorporates four GAP layers for multi-scale semantic aggregation, employs the Hard-Swish activation to enhance gradient flow, and utilizes the Focal Loss function to mitigate class imbalance issues. Experimental results on the IDRiD-APTOS2019, DDR, and EyePACS datasets demonstrate that the proposed framework achieves 93.46%, 82.45% and 79.94% overall classification accuracy using only 4.8 million parameters, highlighting its strong generalization capability and computational efficiency. Furthermore, to ensure transparent predictions, an Explainable AI (XAI) approach known as Gradient-weighted Class Activation Mapping (Grad-CAM) is employed to visualize HIRD-Net’s decision-making process. Full article

Bioactive resin cements are gaining popularity for their clinical benefits, but concerns remain regarding their color stability. This study evaluated the color change (ΔE₀₀) and whiteness change (ΔWI_D) in bioactive resin cements and how their potential discoloration affects the shade of bonded CAD/CAM glass–ceramics at different ceramic thicknesses. VITA Mark II blocks were prepared in three thicknesses (0.5, 0.8, and 1.0 mm) and divided by resin cement: Panavia SA Universal (Pn), Predicta Bioactive Cement (Pr), and ACTIVA BioACTIVE Cement (Ac) (n = 10). Additionally, 10 specimens (10 × 2 mm) of each cement alone were prepared. Color was measured before and after 24 days of coffee immersion. Cement type significantly affected ΔE₀₀ (p < 0.001). Pn had the highest color stability, followed by Pr and Ac, with significant differences between each. ΔWI_D also varied by cement (p = 0.004), with Pn and Pr differing significantly from Ac. Ceramic thickness alone had no significant effect on ΔE₀₀ or ΔWI_D, but its interaction with cement type was significant (p < 0.001). While ceramic thickness does not directly affect the final shade, its combination with resin cement does. Choosing the right resin cement is key for long-term esthetic outcomes. Full article

This scoping review aimed to systematically map the literature on digital workflows for the design and fabrication of customized bone grafts in oral and maxillofacial surgery. The review focused on the integration of cone-beam computed tomography (CBCT), computer-aided design (CAD), and computer-aided manufacturing (CAM) techniques for the production of personalized bone blocks. A systematic search of PubMed, Web of Science, and Ovid MEDLINE identified 151 records published between 2015 and 2025; after duplicate removal, screening, and full-text assessment, 16 articles were included. Six additional seminal studies published before 2015 were considered through manual search to provide historical background. The included studies consisted of case reports, case series, prospective clinical investigations, and preclinical experiments. Customization strategies involved synthetic hydroxyapatite scaffolds, CAD/CAM-milled allogeneic blocks, xenogeneic blocks, and digitally guided autogenous grafts. Four studies provided direct clinical documentation of customized CAD/CAM bone blocks, while the others offered complementary evidence on digital design, scaffold adaptation, or preclinical validation. Outcomes included graft adaptation, volumetric stability, implant survival, and limited histological analyses. Despite promising short-term results, no study has yet described the complete clinical workflow from CBCT acquisition to milling and implantation of a biological autologous or xenogeneic block in humans. This review underscores both the feasibility and the limitations of current approaches, highlighting the absence of fully validated digital-to-biological protocols as the main gap to be addressed in future research. Full article

Background/Objectives: Computer-aided manufacturing techniques are divided into subtractive (milling) and additive (3D printing) techniques. The accuracy of both techniques is measured only indirectly by testing the fabricated restorations. However, the role of the fabrication technique is masked by the differences in the materials used. Hence, this study used the same printing resin to print crowns and blocks for milling. Methods: Ten maxillary first premolars were prepared for full crowns and scanned with Primescan Connect IOS, and then crown restorations were designed using Exocad. A CAD/CAM block equal to size C14 was designed in CAD software (Microsoft 3D Builder) (Version 18.0.1931.0). The designed crowns and blocks were printed using three hybrid ceramic materials, namely, Ceramic Crown (SprintRay), Varseosmile Crown plus (Bego), and P-crown (Senertek), using a SprintRay Pro95S 3D-printer. The printed blocks were then used to fabricate the designed crowns using an In-Lab MCXL milling machine. The trueness and marginal and internal gaps of the crowns were then measured using Geomagic Control X metrology software (Version 2022.1). Statistical analysis was performed using the Kruskal–Wallis test, Dunn’s test, one-way ANOVA test, and Tukey’s HSD test. Results: Generally, the milled crowns showed significantly higher trueness but lower fitness than their 3D-printed counterparts (p < 0.05). A significant reverse correlation was found between the trueness and fitness of the fabricated restorations. Conclusions: The fabrication technique significantly influenced the accuracy of the hybrid ceramic crowns. Milling offered superior trueness, whereas 3D printing resulted in better internal and marginal adaptation. Full article

Curvilinear V-grooves are increasingly employed in functional surfaces with applications ranging from fluidics to tribology and optics. Despite their widespread use, the accurate and repeatable fabrication of curvilinear V-grooves remains challenging due to their inherent geometric complexity and the lack of relevant commercial CAD/CAM systems. To address this, the present study proposes a CAD/CAM integrated framework capable of automating the design and fabrication of functional surfaces comprising curvilinear V-grooves generated by multi-axis single-point diamond cutting (SPDC). The framework is organized into three main functional blocks supported by seven secondary modules that encompass the entire process from V-groove geometry definition to cutting. The developed framework was practically validated by fabricating sinusoidal V-grooves on a flat surface and testing the capillary flow functionality of a curvilinear pattern. These results demonstrate the relevance of the integrated framework to curvilinear V-groove fabrication, thereby offering a versatile solution for certain types of surface engineering applications. Full article

Biomimetic restorative protocols aim to preserve natural tooth structure while enhancing restoration longevity. This in vitro study aimed to evaluate the shear bond strength (SBS) in the repair of additively and subtractively manufactured CAD/CAM materials using bulk-fill resin composites and to assess the effect of thermocycling. Forty rectangular specimens (14.5 × 7 × 3 mm) were prepared from Grandio Blocs (GB, VOCO) and VarseoSmile Crown^Plus (VS, BEGO), and thermocycled (5000 cycles, 5–55 °C, 20 s dwell time). All surfaces were roughened with 50 μm Al₂O₃. Samples were repaired using VisCalor (VCB, VOCO) and Charisma Bulk Flow One (CBO, Kulzer) composites (n = 10 per group) with their respective adhesives. Each group was further divided into immediate and post-thermocycling subgroups. All specimens were tested under shear force until failure, and failure types were examined under a stereomicroscope. Representative samples were examined by SEM to evaluate filler morphology. Statistical analysis was performed with SPSS v23 (p < 0.05). No statistically significant differences in SBS were found between groups (p > 0.05). Mean SBS values were highest in VS-CBO and lowest in GB-CBO. Cohesive failures were more frequent in immediate groups, while adhesive failures predominated after thermocycling. Bulk-fill composites did not influence the repair bond strength of indirect materials. Thermocycling affected the failure type, though not the SBS values. Full article

The aim was to assess the blending effect of universal-shade resin-based composites (RBCs) (Omnichroma—OC; Clearfil Majesty Universal–CM; Venus Pearl—V; Transcend—T) used for repair for lithium disilicate blocks. Fifteen parallelepiped-shaped (10.5 × 10.5 × 3 mm) specimens with four cavities (3 mm in diameter and 2 mm in depth) were designed from lithium disilicate CAD/CAM blocks (CEREC Tessera HT A3) and milled. Specimens were then randomly divided into five groups based on the five resin composite materials for cavity restoration (n = 12): Group 1, control group (F); Group 2 (T); Group 3 (OC); Group 4 (V); and Group 5 (CM). After surface conditioning, composite resins were applied to the ceramic surface. Color measurements were taken with a colorimeter in the center of the resin restoration and on the CAD/CAM block. Tristimulus values were converted to CIELab color coordinates and color differences were expressed in ΔE₀₀ units using the CIEDE-2000 formula. F showed significantly better color matching (ΔE₀₀ = 2.51 ± 0.64) in comparison to single-shade RBCs except T (ΔE₀₀ = 2.55 ± 0.64). All groups exceeded perceptibility and acceptability thresholds. The control group presented higher color matching than the single shade universal composites except for Transcend. Full article

Background: Vertical alveolar ridge augmentation (ARA) > 3 mm is associated with increased surgical complexity and higher complication rates. Despite the availability of various ARA techniques and graft materials, robust comparative clinical data remain limited. This retrospective multicenter study aimed to evaluate and compare surgical and patient-relevant outcomes across seven established vertical ARA techniques. Methods: This retrospective multicenter study included 70 cases of vertical ARA > 3 mm using seven different techniques (10 cases each): an iliac crest graft (ICG), intraoral autogenous bone block (IBB), allogeneic bone block (ABB), CAD/CAM ABB, CAD/CAM titanium mesh (CAD/CAM TM), magnesium scaffold (MS), and the allogeneic shell technique (ST). The outcome parameters included harvesting and insertion time, bone gain (vertical and horizontal, after a minimum of one year), graft resorption (after one year), donor site morbidity, dehiscence rate, need for material removal, and biological and general financial costs. Results: Harvesting time significantly varied among the different ARA techniques (p = 0.0025), with the longest mean durations in ICGs (51.6 ± 5.8 min) and IBBs (36.5 ± 10.8 min), and no harvesting was required for the other techniques. Insertion times also significantly differed between the different ARA techniques (p < 0.0001) and were longest in IBBs (50.1 ± 7.5 min) and the ST (47.3 ± 13.9 min). ICGs achieved the highest vertical and horizontal bone gain (5.6 ± 0.4 mm), while ABBs and CAD/CAM ABBs showed the lowest (~3.0 mm). Resorption rates significantly differed between the different ARA techniques (p < 0.0001) and were highest for ICGs (25.9 ± 3.9%) and lowest for MSs (5.1 ± 1.5%). Donor site morbidity was 100% in ICGs and 50% in IBBs, with no morbidity in the other groups. Dehiscence rates were 10% in most techniques but 30% in CAD/CAM TMs. Removals were required in all techniques except MSs. Biological and financial costs were high for ICGs and CAD/CAM ABBs and low for MSs. Conclusions: Vertical ARA techniques significantly differ regarding harvesting and insertion time, bone gain, graft resorption, donor site morbidity, dehiscence rates, removals, and costs. While ICGs achieved the highest bone volume, less invasive techniques, such as CAD/CAM-based or resorbable scaffolds, reduced biological costs and complication risks. Technique selection should be individualized based on defects, patients, and reconstructive goals. Full article

Aging of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) under wet conditions is known as low-temperature degradation (LTD), which is associated with phase change and decreasing mechanical strength. Herein, we studied the effects of different surface treatments on the LTD of three different commercial Y-TZP blocks utilizing CAD/CAM technology, namely, Cercon^®, e.max^® ZirCAD, and Vita In-ceram^® YZ. The blocks were immersed in 4% acetic acid at 80 °C for 0, 7, 14, and 28 days. The effects of surface treatments such as sandblasting and polishing were also examined. The results showed that the monoclinic phase increased with immersion time in all three brands. In Cercon^® blocks, a minimal amount of phase transformation was observed, with the smallest amount of degradation after immersion. Sandblasting and polishing both suppressed phase transformation. After immersion, the mechanical strength exhibited a small decrease with time. Accelerating the evaluation of the LTD of zirconia may effectively help with clinical applications. Full article